Lead Director- Informatics Reporting

Role Description

The Lead Director – Informatics is responsible for defining and executing the data and reporting strategy for the Grievances & Appeals (G&A) organization, enabling timely, accurate, and actionable insights to improve operational efficiency, compliance, and decision-making. This role builds internal analytics capabilities, strengthens reporting processes, and develops a high-performing team.

What You Will Do:

• Reporting Strategy & Execution
  • Manages and optimizes Informatics reporting processes, systems, and strategies to provide accurate and timely information to key stakeholders.
  • Provides strategic leadership in the development and execution of reporting strategies aligned with the organization's goals.
  • Oversees the selection, implementation, and maintenance of reporting systems, schedules, and infrastructure.
  • Evaluates and recommends appropriate reporting tools, databases, and platforms to support efficient and accurate reporting processes.
  • Collaborates with stakeholders to identify reporting needs and requirements, design and create meaningful visualizations, and ensure data accuracy and consistency.
  • Establishes and enforces reporting governance frameworks, policies, and procedures by ensuring compliance with relevant regulations, such as data privacy, security, and industry standards.
  • Identifies opportunities to enhance reporting efficiency, accuracy, and usability through automation, data visualization, and self-service reporting capabilities.
  • Establishes performance metrics and reporting mechanisms to assess the effectiveness of reporting initiatives.
  • Acts as a bridge between IT delivery, enterprise analytics, and clinical/Operational leadership to ensure risk management and regulatory compliance needs.
• Advanced Analytics & Insights
  • Leads teams of data analysts and specialists to analyze core G&A data and generate actionable insights.
  • Enables visibility into:
    • Appeals turnaround time
    • Overturn reduction drivers
    • Grievance trends
    • Root cause analysis
    • Regulatory performance metrics
    • Productivity Metrics
  • Drives proactive insights for operational improvement and compliance readiness.
• Governance, Compliance & Quality
  • Ensures adherence to healthcare regulations and audit requirements specific to grievances and appeals.
  • Maintains high standards of data integrity, traceability, and auditability.
  • Aligns reporting practices with enterprise data governance standards.
• Internal Capability Development
  • Builds in-house informatics and analytics capabilities to reduce reliance on external teams.
  • Establishes scalable operating models, reusable data assets, and self-service solutions.
  • Drives continuous improvement through automation and standardization.
• Team Leadership & Development
  • Creates robust job functions and role clarity within the informatics team.
  • Leads, mentors, and develops talent across analytics, reporting, and domain expertise.
  • Promotes a growth mindset, agility, and continuous learning culture.
• Healthcare Domain Focus (Critical)
  • Applies deep expertise in:
    • Healthcare claims, grievances, authorization and appeals processes
    • Appeals lifecycle management and compliance tracking
  • Ensures data and reporting enable regulatory compliance, audit readiness, and operational excellence.

Qualifications

• 10+ years of experience in informatics, analytics, or business intelligence
• Strong healthcare domain experience, preferably in:
  • Claims, grievances, authorization and appeals
• Demonstrated leadership in data strategy, reporting, and team development

Requirements

• Experience in Aetna EDP platform.
• Experience in GCP (Big Query, Looker, Cloud).
• Experience in implementing AI technologies into existing reporting processes.
• Experience with Coginiti, Dataiku, Tableau, PBI, SAP reporting tools, Quick Base.
• Familiarity with Agile SDLC.
• Proficient in Office tools (PowerPoint/Excel/Word) and SharePoint.
• Experience engaging with executive leadership.
• Experience in identifying and implementing process improvements.
• Experience leading analytics team and translating their requirements into clear, actionable solutions.

Education

• Bachelors Degree Required, Masters Preferred

Pay Range

The typical pay range for this role is: $100,000.00 - $231,540.00. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.

Benefits

• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.

We anticipate the application window for this opening will close on: 08/21/2026. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.